Mi Cy2003

271729
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) (IA i y C. CERTIFICATION #.�1St
WELL CONTRACTOR CO\IPANT NAME • k2S4-1 Cr PHONE # fp?eZ,-`�i
ciI
STATE \\ELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential ID, Mtmicipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 _ Other 0 If Other, List Use
WELL LOCATION:
Nearest Town: spt GiLE - IAi County_1\11\
2 ( -- M5 hI b D(ILf r�
(Street Nome. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: k\/ tl-z A 1. e
Address y e.0 C>L (> Da 4( CAI
(Street or Route No.)
S (feu,P. it 2 -?77
City or Town State Zip Code
)-
Area code- Phone numbe
4. DATE DRILLED 5-2c- 6
5. TOTAL DEPTH: 0 ei7
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO R-
7. STATIC WATER LEVEL Below Top of Casing: 6.o FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS f FT. Above Land Surface*
*"fop of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm)' 1© METHOD OF TEST 4 /I
10. WATER ZONES (depth): /trq/p jut f- 2,00
I I. DISINFECTION: Type
12. CASING:
3
Depth
From To Ft.
From 0 To %g Ft.
Fromf<% 41 Toicir, Ft.
13. GROUT: Depth Material
From To _ Ft.
From 0 To A 3 Ft. '-nipitt
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Diameter
TT graphic/Land setting
rui-r ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Desyription
r) - 1 8.5"
JJ
LOCATION SKETCH
Amount ' , C) `✓ 7 i Show direction and distance in miles from at least_
Wall Thickness two State Roads or County Roads. Includ f9e road
or WeighttFt. Material numbers and commo road nafnes.
From To Ft.
From To Ft.
_a_REMARK¢.
_7
0
Uc?b Lfa2c-
i± f
J
I
r. I.:DOlikKariCEiT1FY T
CONSTRUCTION STANDA
HIS \ E
AN
WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
T A COPY OF-TH1.S RECORD II*S-BiEN PROVIDED TO THE WELL OWNER
'r L
IGNATURE OF P
STRUCTING THE WELL DATE
SU(imit the 6rigifiiti �alt_e Div sion of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
4
�7499-16it6-P-in-ae-Plo. ('}{5l) 733 6221, within 30 days. GW-1 REV. 07/2001

2 7 5758
10. WATER ZONES (depth):
CASING: m Thickness
Material
0 To 53 Ft. _ �/-1 LL's N
Method
WELL CONSTRUCTION RECORD •
North Carolina - Department of Environment and Natural Rcso ces - Division o Water r Quua�a��1y - Groundwater Sec{ieg,��
� yy��,� s ` � �/A�CERTIFICATION Nola
WELL CONTRACTOR (INDIVIDUAL) NAME (printiwaYt ����' {/ 11� r M:
F II ^I� PH ONE • r�.f.:7�-1i-ibs{.V
M'E I,t. CONTRACTOR COMPANY NAME .L
ASSOCIATED WQ PERMIT G�iD
STATE WELL fappIcable CONSTRUCTION PERMITN (if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residential Eii Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT ON: C
Nearest TOWt kexsy11`e County 27,106
kd
7e52, #t�t� Za-4 N ,134. .dfl1e
( Street Name. N'um en, Community. Subdivision, Lot No., Zip Code)
3. GW'NER7 `�SC
Address 2 S;
(Street or Route N ..) Z� r/O
1-1_WiS-V115 a yip Code 1
City or Town State
Topogra is/Land setting
❑Ridge lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrecslninalesiseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
Area code- Phone numbcs
4. DATE DRILLED_ C7 • Z. 3- 3
5. TOTAL DEPTH: 205
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO eke
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS l , FT. Above Land Surface'
Top of casing terminated at/or below land surface requires s
variance In accordance with ISA NCAC 2C .0118.
•
9. YIELD (gpm): (j METHOD OF TES
T>Q.N+4p-
tJ
S
0
r-
J
•
j
j.00ATION SKETCH tV
Amount Show direction and distance in miles from at easC
1 I. DISINFECTION: Type �- two State Roads or County Roads. Includcgnt ro;T
12. Wall Wei k
Depth Diameter or Weight/Ft. numbers and common road names.
From To Ft.
From To FL
(3. GROUT: Depth erial
From To Ft. Mati �•t.tX.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From _. To_.__ Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: Material
Depth Size
From To Ft.
From To Ft.
I6. REMARKS:
1 I {:' DE)4EBf CERTW
1(S HL C''ONSTRU ON STA}
Submit the or glint to_Ahe Di
X 4AR-i G1F': QMu^c lf"oEij^919) 733
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
%' Z-
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ision of Water Quality, Groundwnter Section, 1636 Mail Service CeenAtteeri Raleigh, NC
322I, within 30 days.

r—_.
ms 1Cc
.Area code- Phone number
4 DATE DRILLED
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment ands Natural Reso c �-LDivision? Q Wat)err Qua
WELL CONTRACTOR (INDIVIDUAL) NAME (�Apri�tn�t)yyk.bYt e ��\�/+�'j 7 7l� yM1C.Cs���'��, AAA
WELL CONTRACTOR COMPANY NAME A Iti.0 lbw �•{(`•`\/'.1Jn Vi i
ASSOCIATED WQ PERMIT
STATE WELL CONSTRUCTION PERMIT/4
tifapplicable) (if applicable)
,,,,/1�� t Groundwater Sect .03t
V CERTIFICATION #7 I1a
•
PHONE # iifrs t1
`� 'ZICs'5L
I. WELL USE (Check Applicable Box): Residential W Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: Topographic/Land setting /
Nearest Town:,)Ysi�jCY si�C County ellelt � ❑Ridge ❑Slope ❑Valley Mat
%01/4 1�hY'Ly 2S -C s {.�,, rivS Mt r„p� (check appropriate box)
J m �GC� �•�' ` ZipCode)Latitude/longitude of well location
(Street Name. Numbers, Community. Subdivision, Lot No.,
3. OWNERTHN 130* &yY
AddressAL
Lhoi
�-/3'0 ��/ 9(]p �(y -�y1
�r70 •Igl Stre tV;;'�Ni \ \ ,NQ tin O
City or Town State Zip Code
( )-
4-zc4-t3
5. TOTAL DEPTH: Z05 r
6. DOES WELL REPLACE EXISTING WELL? YE$ ❑NO Q'
7. STATIC WATER LEVEL Below Top of Casing: LO
V
1 (Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
9. YIELD (gpm): METHODrah
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
variance in accordanc with ISA NCAC 2C.0118. ( . `
CJI OF TES 1 r w�ZU
10. WATER ZONES (depth): ( I0
11. DISINFECTION: Type 'b1ec Amount Z
12. CASING: Wall Thickness
/�
Depth - Diameter or Weight/Ft. Material
From O Toy Ft.
From To Ft.
From To FL
13. GROUT: Depth ��M��ater
Material
From To Ft.�.RS�=t>A st
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To
From To
Ft.
Ft.
Size Material
c.>
C—
r—
f—
t
0
t
-
-,o
LOCATION SKETCH c.
Show direction and distance in miles from at asto
two State Roads or County Roads. Include the road
numbers and common road names.
Method
tr..) p; 44 iti- --- •
03) Sr- K a
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANL RDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Ca•3b-o3
SIGtdATURE OF PERSON CONSTRUCTING THE WELL DATE
i!
Submit the original to the Divis_kin of Water Quality, Groundwater Section, 1636 Mail Service Ceentter' RRaaleigh, NC
27699-1636 Phone No. (919) 733=3Zz1 within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N tural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) . \ft N-t'. �6I%2e CERTIFICATION #-7r%3-%ney
WELL CONTR:\CTOR COMPANY NAME t�l &-4' I ( I', en PHONE # 1'3- 760. ,
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED \VQ PERMIT#
lifapplicablc)
(if applicable)
I. WELL USE (Check Applicable Box): ResidentiaFf Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELLLOCK-V.9Ni
Neart-st Toown: '2IC
/v . etoee
County )14 )j 1/
(Street Name. N ibrs. Community, Subdivision, Lot No-, Zip Code)
3. OWNER:
(Street or
Route No.)
,c eke r
City or Toy/d State Zip Code
Address )c:Ic, ;2 .Nl— 3j /NSF_
k' k roc 601
bass )- x5"-(c-7539 7ecc '= 4,4..TIS
Area code- Phone ttuntber
4. DATE DRILLED
5.TOTAL DEPTH: _
6. DOES WELL REPLACE EXI
275591
pographic/Land setting
Ridge DSlope ❑Valley DFlat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Foati9n Description
DEPTH
From To
O- 3
3- /cam
0- %19
66 - 6>.7
TING WELL? YES ❑ NO ❑ (--)_ Thae
7. STATIC WATER LEVEL Below Top of Casing: RC= FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance...\ith ISA NCAC 2C .0118. A t
9. YIELD (gpm): 7 METHOD OF TEST AP &
10. WATER ZONES (depth): 77 /30, 2te*
t
11 DISINFECTION: Type diSKI - Amount 6 mZ.(
12. CASING: Wall Thickness
Depth Diameter or Wei ght/Ft. Matey 1
From e) To G� Ft. 6 "5' , in fV
From To Ft.
From To Ft.
13. GROUT: Depth Materi Method
From___CL To 425 Ft. era _J-5.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To
Ft.
From To Ft.
r—
O —
LOCATION SKETCH
Show direction and distance in miles from feast;
two State Roads or County Roads. Include roaaz,
numbers and common road names.
-U ri
N r-,_.
O
16. REMARKS:
I DO HEREBY CERTIFY THAT Tr1IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTIO ' TANUAR D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
I��- G 63
I
Submit the original to th4 Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, INC
{',7699-1636 Phone No. (919) 733-3_21, within 30 days. GW-1 REV. 07/2001
c c r-ilrN
GNATURE OF PERSON CONSTRUCTING THE WELL DATE
0

275587
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Res urces - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (printi<' V1 2,—,+ abeASOA) CERTIFICA�TION# 2 90
WELL CONTRACTOR COMPANY NAME LL_'e it 0-eeil 'rRr'Ii Nq n, PHONE fryb'
g)733-a ea.
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PER:MIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential r Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: ?cc ?in-te County /7114 Ae11
rb S ks
(Street Name, N t hers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: rRQ+4 DJ& (3
Address, /o ,"L•
s1
Stre or Route No.)
c.
d87CS
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED la- l' -OZ-
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXIS ING WELL? YES 0 NO Cr_r-
7. STATIC WATER LEVEL Below Top of Casing: SO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS \ FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): ) 111 - METHOD OF TEST A T 2
10. WATER ZONES (depth): 7 tl1C 1550
1 I. DISINFECTION: Type r 6-o2 Amount (G+ eta.
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To ;r'? Ft. "-i SSR a t t\IC.
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From C-> To FL c_e o &mac' ''C .._
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To FL
From To Ft.
�6pographic/Land setting
tdge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0 - ti I as R
an --'-/a 7)R
yc-3LU
raJ
c-
r—
v
LOCATION SKETCH -o rot
Show direction and distance in miles from afleAf
two State Roads or County Roads. Inclugt e rag;
numbers and common road names. o�
- 'cs
-
=cfT1
rn_
of
to
--1
O
0
01
Q1
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
)NSTRUCTt6N. ST N�iPritt.)S, A n-IUAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original tojttTPU vision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
!I 27699-1636 Phone No. (9 9) 733-3221, within 30 days. GW-1 REV. 07/2001

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
274886
WELL CONSTRUCTION RECORD WELL CONTRACTOR:
Dewey Wright Well Pump Co.,
WELL CONTRACTOR CERTIFICATION #t
20
030117 STATE WELL CONSTRUCTION PERMIT*Steve Petty
WELL USE (Check Applicable Box): Residential 7 Municipal I I Industrial ❑ Agricultural I I Monitoring E
Recovery ❑ Heat Pump Water Injection I I Other I If Other, List Use'
2. WELL LOCATION: (Show sketch of the location below)
B KERSV LIE h,11TCuELL
Nearest Town: County:
CHET BURLESON RD. OFF HWY 281 OFF MT/Y 19E
I Road Name and Numbers, Community, or Subdivision and Lot No.l
3. OWNER ROBERT A BURLESON
Address 5521 NC HWY 281
BAKERSWte_tt8 Rote o) NC 28705
DRILLING LOG DEPTH
From To Formation Description
0 15 DIRT
15 /0 StAiVilt
City or Town
4. DATE DRILLED =0^
5. TOTAL DEPTH
6. CUTTINGS COLLECTED YES I I NO ❑
7. DOES WELL REPLACE EXISTING WELL? YES NO
8. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+' if Above Top of Casing)
State Zip Code
3/28/2003
9. TOP OF CASING IS 1 FT Above Land Surface*
Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0110 Alf
10. YIELD (gpm): METHODpm?FO-! TFtST
n
11. WATER ZONES (depth):
70 230 GRANITE
230 232 SHALE
305 GRAN! rb
L
'1 ppm isLt-2t2
u Rpm a Clprn
HTH L7
12. CHLORINATION: Type Amount
13. CASING
Depth Dian %
nn
From O To Ft
From To Ft
From To Ft
14. GROUT:
Wall Thickness
or XVJiQht/Ft.
Ivterl
Depth Material Method
From 0 To 2L Ft Leman: Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth
To
To
17.
From
From
Ft
Ft
A1-TH
GROUNDWATER SECTIO
rial INDO:taiLII_BELIMIAL OF
Size Material
If additional space is needed use back 6forrril
0
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
6
erlf
Ile_
ChM- Be< got •
LL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
HAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
SIGNATURE OF PERSON CONSTRUCTING b'fE WELL DATE
Submit original tobivision of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

E
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quail
WELL CONTRACTOR (INDIVIDUAL) NAME (print) (.954 I Gg
WELL CONTRACTOR COMPANY NAME I IJS4) GF LYDIA. D f ( .t.x
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
274790
ty - Groundwater Sectionioj
CERTIFICATION(' # C.. /J c
PHONE # tll�li 729'Q 3/
1. WELL USE (Check Applicable Box): Residential Municipal/Public lit<r7dustrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION: n •
Nearest Town: 5P,?�n GC$ toe County 1t s rt k��'
C &7O- * o-o 2 d
(Street Name. Numbers, Community, Subdivision, Lot No, Zip Code)
t
3. OWNER: Bat &q)�-. p tf—di
Address 'f% t%CQ On IGc!
(Street or Route No.)
*i2 Otte /i Q. 2,0977
City or Town State Zip Code
E)- 7iole' 7972
Area code- Phone number
4. DATE DRILLED inify / a(7U
5. TOTAL DEPTH: 4;105
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: /5-- FT.
(Use "+•• if Above Top of Casing)
8. TOP OF CASING 1S % ye._FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): / T . METHOD OF TEST /9/2
10. WATER ZONES (depth):
Topographic/Land setting
❑Ridge O'STope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
f) '70 pirzF
7L, yo s
I I. DISINFECTION: Types'Zeir i A)C.. Amount Fin e 73%
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From To Ft.
From _0 To 76 Ft.
From /(v To %B Ft. %r !aR
13. GROUT: Depth Material
From To Ft. r
From 0 To cuJ Ft. r2 ej
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15.SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Method
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the mid
numbers and common road names. r=
_„
26'/1
.G"
7inf
cickt
I DO HEREBY CERTIFY THAT THIS WE,L WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, ANDDT T A COPY OF THIS RECO a - - : " 0 VIDED TO THE WELL OWNER
(
Submit the origii
27699-1636 Pone
a
SIGNA`t'URE i F P CONSTRUCTING THE WELL DATE
he Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
9) 733-3221, within 30 days. GW-1 REV. 07/2001
GROUNDWATER SECTION
ASHEVILLE REGIONAL OFFICE

WELL CONSTRUCTION RECORD ..
272527
North Carolina - Department of Environment and Natural Resourcesl- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)'Als/i t->xez�N CERTIFICATION#°'`��10
WELL CONTRACTOR COMPANY NAME 13,2A5a_,ri ( Oct ( ai(2 . 1 (i PHONE # (1+3$) 733` ? cq
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERw1IT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential ti lunicipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: I-e �gM-&. County_11d
L( f —1 r''AIL C.2 r ch. '?
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: ,4!,y-1frisc CRC.e D
Address Lj`P i Baru' C» C-hi -7 \
(Street or Route No.)
as.z`-y .c... 02c70S
• City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED ll�a��vg�g
5. TOTAL DEPTH: 54'10.i_.3i-
6. DOES WELL REPLACE EXISII'ING WELL? YES ❑ NO e
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): '�2- METHOD OF TEST Ai cc.
10. WATER ZONES (depth): ?.NMI ayii
11. DISINFECTION: Type eh tOti N N-- Amount C-.=
12. CASING: Wall Thickness
Depth Diam Icr or Wub rl/Pt. Mate{__
From C.?To 'll Ft. G-6f4 _P(LV.
From To Ft.
From To Ft.
13. GROUT: Depth Matiriat From e To2j Ft. Cam'= P Method �•
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topogr tc/Land setting
❑Ridge Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(d egrccs/minutes/seconds) . -
Latitude/longitude source:OGPS❑Topographic map
(check box)
DEPTH - DRILLING LOG
From To Formation Description
0 56 d,x-i 1m<. -e.f
c —.- lc% c�2an.>1z. y h, u .
ciQ,cic. S-e w'Sk.
1-Y)— '5yk)
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
O
W
-CC
s
O
c11
c
0
-z
c^
m
ern
o<
Lrz
>0
CA=
fnxrrt
O
2
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STgNFFDARDS, THATA COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
i
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit -the original tt4!ith, Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 ('hone No. ( 753-3221, within 30 days. GW-I REV. 07/2001

2'7 2 5 2 0
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
// � < qq
WELL CONTRACTOR (INDIVIDUAL) NAME (print) /^�.V,t� SfN\i CERTIFICATION itR91t'
WELL CONTRACTORCOM ['ANY NAMEWAS.tcwAIII eniw-11 J%itl�i N'1 PHONE # ( i 1133'<7(C
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ❑ Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring O Recovery O Heat Pump Water Injection O Other O If Other, List Use
2. WELL LOCATION:
NearesttToywip 'Z
iC61 t-1 t
County m;•t+-h2i 1
(Street Name, Numbers,, Community, Subdivision, Lot No., Zip Code)
3. OWNER: `�1 iJ-xJA a/
Address (i°t'7 it, CR. ?
1 n -4($pe^t or Route Not)k.‘49At
City or Town State
Zip Code
Area code- Phone number
4. DATE DRILLED _-a5"C
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISING WELL? YES O NO Ea'
7. STATIC WATER LEVEL Below Top of Casing: )c FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance h 15A NCAC 2C .0118.
9. YIELD (gpm): MET�-IOD OF TEST \
10. WATER ZONES (depth): SS/+. TOP r ; o4
11 DISINFECTION: Typejh o(7 itX Amount l�
12. CASING: Wall Thickness
or Weight/Ft. Material
St* PQ
Depth
From © To J Ft.
From < To ba Ft.
From
GROUT:
From
To Ft.
Depth r� Material
�.'7 To ' Ft. cs*rnc't-='t -
Diameter
C IAi
G -'' - .. I 13(.;:
From To Ft.
SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To
Ed
setting
edge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH - DRILLING LOG
From To Formation Description
Ir
qa- I'- f 1.i esRek-ti. , 4E_
Method
Slot Size Material
in.
in.
Material
Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
O
CO
O
U1
Q1
16. REMARKS:
RI%T} N�fA
JUN 1 0 2003
Submit the original to t
?it VII
;_,EFICF
HIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
a- a5-o,s
1GNATURE OF PERSON CONSTRUCTING THE WELL
DATE
e Div sion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
733-: 221, within 30 days. GW-1 REV, 07/2001

27251'7
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section WELL CONTRACTOR (INDIVIDUAL) NAME (print) 1.4QUi N Ro bQdSU/O CERTIFICATION # 7V 1q
ep
WELL CONTRACTOR COMPANY NAME S�RASUQ-I' LOe II 1.)Ri i1 r(^-0 PHONE # �t9w)73Z—gCOx
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED JWQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: II
Nearest Town: -j AlekQR Su\ I\f County /✓1 i he t
2% Frig k Ivv-L `Rdr CR-,ia. nma czt s+ 1)
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: (.lid)" j t Address
(Street of feoute No.)
City or Town State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED /0--
5 TOTAL DEPTH ) KC2 X
6. DOES WELL REPLACE E ISTING WELL? YES ❑ NO irr
7. STATIC WATER LEVEL Below Top of Casing: r 0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS \ FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118. c
9. YIELD (gpm): S METHOD OF TEST AAA
10. WATER ZONES (depth): JJ ya'aL 13S 1 501 ;Au-
lt
. DISINFECTION: Typeeh10f2i N e-- Amount 7c1Z .
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Materia
From 0To c) 1 Ft. Co 'g 1W `�A-1 V
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To DO Ft. C -' --9 4 r;'k
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
�opographic/Land setting
idge ❑Slope DValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Eormation Description
D0:—re au k Jew.,pccon
�1-rrs.
Cam- ;9 O r�RR
t40 I ! c,k -4ccfc
C jk=1 - Rc-c.K
,ys—leso r� �.
LOCATION SKETCH
Show direction and distance in miles from at Ieac�L
two State Roads or County Roads. IncludSe r o
numbers and common road names. W
16. REMARKS:
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
S, AND THAT A OPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
fcO--23- 6
SIGNATUR OF PERSON CONSTRUCTING THE WELL DATE
Submit the nri ig nai 1{r the t ivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
2169* 16tCOtotte Nn,..(919) 13-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)/ •'-Vwk)— 7 beg Cf)N CERTIFICATION #2sc%ist,
WELL CONTRACTOR COMPANY NAME'RG µ. tsiajj Drat) /f-C PHONE # {iS7S)73)-oic{
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED4`VQ PERMIT#
(if applicable) (if applicable)
272516
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: r
Nearest Town: 1XWc l-Ao _ County Ill; le
II3fo CavArg5 44-\
(Street Name, Numbers, Community, Subt ision, Lot No., Zip Code)
3. OWNER: . r C )C%i NiU ej
Address t) 3t, C A o*'R'S 71?.- se �a
Street or Route No.)
City or Town State
( )-
Zip Code
Area code- Phone number
4. DATE DRILLED /0 — O D.
5. TOTAL DEPTH: ' )
6. DOES WELL REPLACE E STING WELL? YES ❑ NO Er
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS t FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordanc with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST
10. WATER ZONES (depth): `s0/ )os, Z(,Q
11. DISINFECTION: Type LktesID / .as
12. CASING:
Depth Diameter
From U To (C Ft. C, `14-1
From
From
13. GRO
From
From
14. SCREEN:
From
From To Ft.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
UT:
To Ft.
To Ft.
Depth Material �r Method
0 To ,.) Ft.cc ... =
To Ft.
Depth Diameter Slot Size Material
To Ft. in. in.
in. in.
Amount Ls
Wall Thickness
or Weight/Ft. Material
SDR.21 INC
16. REMARKS:
�LIDO HEREBY CERTIFY'TF
CONSTRUCTTON STAND,
J
Size Material
topographic/Land setting
Ridge OSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
1
h,icm- tzt
jLJn
DEPTH
From To
Hs- 3c3O
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
1 a D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
GPi$* bk44ift4TkkkoRfgioa to the B ivision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
AS:.
944UrPrhbeeCti10§191713-3221, within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD 277023
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
;;
WELL CONTRACTOR (INDIVIDUAL) NAME(print)/CQY}� bejp�3 CERTIFICATION #g fjf
WELL CONTRACTOR COMPANY NAME rJ e )/(
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
I. WELL USE (Check Applicable Box): Residentiale."Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:
14, , (t
County
�/}�J r kkii•
(Street Name, Numbers, Col imunity,tSubdivision,!''t No., Zip Code)
3. OWNER:--
Address
trect or Rout No.)
A.
Cny or Towp' Sic Zip Code
Arca code- Phone number
4. DATE DRILLED G-25-a3
5. TOTAL DEPTH: `1GQ
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Pr
7. STATIC WATER LEVEL Below Top of Casing: SO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ( FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD (gpm): ip4-; METHOD OF TEST A» (1-
10. WATER ZONES (depth): /35—_2v
1 I. DISINFECTION: Type r k t ,
12. CASING:
Amount �c
Wall Thickness
Diameter or Weight/Ft. Material
From 0 Ft. e 4 Sp{?VC.
From Ft.
Ft.
13. GROUT: Depth Material
From 0 To.5— Ft. c-,
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
Depth
To /31
From To
Method����JJ
Slot Size Material
in,
in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
PHONE # tiJo)733—aeca-R
topographic/Land setting
tdge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To • Formation Description
�— ran cta
tat — Lien cipA v.
n
W
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include tlroa tt
numbers and common road names.
N tn--
O rJ
LIDO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDA S, AND THAZA CIPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1
251(13
I Submit the original to the
1 .27699-1636 Pht(919)
(RCI 7E1? PA-CHION,
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
r33-3221, within 30 days. GW-I REV. 07/2001
To

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
276886
WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 2686
030232 STATE WELL CONSTRUCTION PERMIT#: Leslie Reece
1. WELL USE (Check Applicable Box): Residential 1 ?tj Municipal Industrial ❑ Agricultural 1 1 Monitoring
If Other, List Use:
Recovery 1 Heat Pump Water Injection ❑ Other
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BURNSVILLE County: MITCHELL
BEANS CREEK RD OFF RAN 226 OFF MINE CREEK OF
(Road Name and Numbers, Community, or Subdivision and Lot No.)
DRILLING LOG DEPTH
3. OWNER NATHAN BYRD From To Formation Description
Address 551 BEANS CREEK RD , 0 60 DIRT•
BAKERS Y1tt Route No) NC 28705 60 94 GRANITE
City or Town State Zip Code
94 95 SHALE
4. DATE DRILLED 5/20/2003 95 125 GRANITE
5. TOTAL DEPTH 125
6. CUTTINGS COLLECTED YES El NO
7. DOES WELL REPLACE EXISTING WELL? YES I I NO
8. STATIC WATER LEVEL Below Top of Casing: 10 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
"Top of casing terminated at/or below land surface requires a variance in accor-
dance YIELD(g
pm):
2c.o11,tj0
10. METHOD OF TEST Air
11. WATER ZONES (depth). 20 ppm 94-95 0 ppm
0 ppm 0 ppm
1
1 XI
0
W
r=
N
12. CHLORINATION: Type HTH
Amount
23
cn -:-
N r--1
If additional space is needed use backs`•form`-.
4•
13. CASING: LOCATION SKETCH
Wall Thickness
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To 63 Ft 6 1/8 .350 PVC L oads, or other map reference points)
From To Ft �QQ Q
From To Ft
14. GROUT: t� 4)
Depth Material Method Ca
From 0 To 20 Ft Cement Gravity Flow E
From To Ft /�
s
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS.
I DO HEREB
CONSTRUC
FOR OFFICE
Quad No:
Serial No.
TIFY THAT THIS WELL'WA
ARDSANDTHAI A
of
aa�
ffeesvii
Ge_
JSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
Y OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
�7 /g-c23
S GNATURE OF SON CONSTRUCTING THE WELL DATE
Submitlorigin I to Division ofGGJJater Quality, Groundwater Section within 30 days
GW-1 REV. 12/09
1JJFF.:SECTION
�a>', _LE KWDi'!AL DFbIOE

WELL CONSTRUCTION RECORD 278290
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) C2 A t21,, ,rn�I }s-FI c e. CERTIFICATION pa/Sv
WELL CONTRACTOR COMPANY NAME 30y?e ct but 0 ri tt sit PHONE #
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELLLOCATIO
Nearest Town: /3 ,c srrlie, County_Glade
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: AG'[oy- /r/OA4l[ti—
Address 39(0.•
(Street or cute No.)
{S• ¢t1Gf.Q6 /L/L 2 e2) 7
City or Town State Zip Code
( )- W go— 9 93/
Area code- Phone number Q v
4. DATE DRILLED 67-23-e3 i00- -%8S
TopograBbic/Land setting
❑Ridge I175(ope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
5. TOTAL DEPTH: </ 35
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO f�
7. STATIC WATER LEVEL Below Top of Casing: eaO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S / FT. Above Land Surface*
`Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0I18.
9. YIELD (gpm): ,3 O METHOD OF TEST 19 //C
l0. WATER ZONES (depth): /9,ow,.1-y 36
.2 '3 4-7 446
II. DISINFECTION: Type tt,QQ4 -em., Amount goZ&7 %
12. CASING: Wall Thickness
Depth
From 0 To /JO Ft
From{ O To 1 /L Ft.
From To Ft.
13. GROUT: Depth
From To Ft
Material
From 10 ToZ 2,_ FL Z f//' i
14. SCREEN: Depth Diameter Slot Size Matenal
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
or Weight/Ft. Material
vo PrIG
Method
From To Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names
I DO HEREBY CERTIFY THAT THIS WEL4WAS CONSTRUCTED 1N ACCOREANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND A COPY OF THIS CO EN PROVIDED TO THE WELL OWNER
SIG URE OFPRSON
Submit the original to the Division of Water Quality, G
27699-1636 Phone No. [phone], within 30 days.
STRUCTING THE WELL
liter Section, 1636MainS lit
'I l�
DATE
enter - Raleigh, NC
GW-1 REV. 07/2001

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
278126
WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #' 2887
030381 STATE WELL CONSTRUCTION PERMIT#' Steve Reece
1. WELL USE (Check Applicable Box): Residential Municipal ❑ Industrial ❑ Agricultural I I Monitoring ❑
Recovery CIHeat Pump Water Injection Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: SPRI ICE PINE County: MITCHFI I
OFF CARTER RIOGF RD OFF HWY 776 OFF 1QF
(Road Name and Numbers, Community, or Subdivision an Lot o.)
3. OWNER KFNNFTH W HOI I IFIFI 11 / SHARON HO1 I IFIFI r)
Address 174 RAY WSFMAN RO
SPPI 1CP (Street owe o. NC
')9777ode City or Town State Zip
4. DATE DRILLED 7/7A/7nnA
5. TOTAL DEPTH AAn
6. CUTTINGS COLLECTED YES I I NO
7. DOES WELL REPLACE EXISTING WELL? YES NO
8. STATIC WATER LEVEL Below Top of Casing: 5n FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 50 METHOD OF TEST Air
11. WATER ZONES (depth): 1 gpm 70-72 8 gpm 210-212
13 gpm 340-344 30 ppm 360-363
12. CHLORINATION: Type HTH Amount 67
DRILLING LOG
From To
0 55
DEPTH
Formation Description
OIRT
55 70 GRANITE
70 72 PI-IAI P
77 91n
_GRANITE
210 217 OLIAP17
917 'MO GRANITE
San Ado Ol1ART7
Add A60 GRANITF
360 36A OI JART7
383 380 GRANITE
13. CASING:
>d
Wall Thickness
Depth Diameter or Weight/Ft.
From 0 To 81 Ft 8 1/8 .350
From To Ft
From To Ft
14. GROUT:
Material
PVC
Depth Material Method
From 0 To 20 Ft Cament Gravity Flow
From To Ft CEMENT GRAVITY FI OW
15. SCREEN:
Depth Diameter Slot Size
From To Ft in in
From To Ft in in
From To Ft in in
Material
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
N9elrirrr?nwm.„1 �Fi1tl1Y45L' EL�'r'WF••
.. r..a T • N SK TC
tion and distance from .�--
1
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV
State
PPP'
Quad No:
Serial No.
2/99

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) (:Ae, 1 ts4-1 G j CERTIFICATION42)W
WELL CONTRACTORCOMPANY NAME c \idjS?r:U_'I y�q PHONE # ( ) !Z 4-4 S-4g
SLATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
278280
1. WELL USE (Check Applicable Box): Residential 6V Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: pp �q�
Nearest Town: 5 JJC E X iKCounty Y v `t
(Street Name. /Nuumbers, Community, /Subdivision, Lot No., Zip Code)
3. OWNER: C714"t1 W1 �"LUYLF
Address Po (i 4 7e GC)
(Street or Route No.) `3iUCf
L.i11-e Swt N&
City
or Town tale ZipCode
( )-76S- ' f(1
Area code- Phone number
4. DATE DRILLED (o - Z r 0 3
5. TOTAL DEPTH: 3L> -/
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 13
7. STATIC WATER LEVEL Below Top of Casing: at. FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S 1 FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 40 METHOD OF TEST 'A t r-
10. WATER ZONES (depth): 209,04 P 00'
I1. DISINFECTION: Type(l,IPrtwe. Amount (e>OZ e-ito
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To FL (44 >y� P0-e
From To r99 Ft. to lid QC) PJa
From"A9 To 30 Ft. (a Ye{ IcS6 C-TN Li/
13. GROUT: Depth Material Method
From To Ft.
From U To Q-Z FL at! P
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge ❑Slope alley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
��— Z° 0,-RE 5141/JZ L
Op(
Z0-Z
Zz- 7,2s
Sc�jr / i c iC
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
Po acee
I DO HEREBY CERTIFY THAT THIS WE WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND I AT A COPY OF THIS REC HAS BEEN PROVIDED TO THE WELL OWNER
%.aSS ra
SIGNATURE OF P t D SON IYONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Grotln$l i titer Section, ii63&MakSe
27699-1636 Phone No. [phone], within 30 days.
L L
enter- Raleigh, NC
GW-I REV. 07/2001
GROLF,A1.":'TER SECTION
nCHRt.I F RFhI(iTIPI (IFFWF

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
27R934
WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 2681
020705 STATE WELL CONSTRUCTION PERMIT# Steve Pelty
1. WELL USE (Check Applicable Box): Residential L .i Municipal ❑ Industrial in
Recovery ❑ Heat Pump Water Injection 1 1 Other ❑ If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: SPRUCE PINE
I NY761
1 cad Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER C'HARI FS R HARRFI I
County: MITC'HFI L
Address 65 SHADy 1 ANF
PAKERSCItntgRoute No.) NC 71j705
City or Town State ip ode
4. DATE DRILLED 8/12/2003
5. TOTAL DEPTH 1n5
6. CUTTINGS COLLECTED YES ❑ NO
7. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
8. STATIC WATER LEVEL Below Top of Casing: 7n FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm)' 20 METHOD OF TEST Air
11. WATER ZONES (depth): 20 gpm 73-74 0 gpm
0 gpm 0 gpm
12. CHLORINATION: Type HTH Amount 18
13. CASING:
From
From
From
Depth Diameter
0 To 55Ft 81/4
14. GROUT:
To Ft
To Ft
Wall Thickness
or Weight/Ft. Material
.188 GALV
DRILLING LOG
From To
Agr
r UNH.
ASi E' IL. ��TFj �l_ 0' ECE
Formation Description
n 5n ROCKS SAND
5n 7Z GRANITE
73 74 SHALE
74 105 GRANITE
c
o
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft CEMENT GRAVITY FLOW
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
I >4
I xl
N -
r*n
cn
�m
— "Er-.
a,-
ss
If additional space is needed use bacEf for
LOCATION SKETCH cd o
(Show direction and distance from at least twocitate
Roads, or other map reference points)6 ttp •
Shady Lang
II 0
OrD-111-
y,„.6 y'I I I.Z
P"
0
54`uriL
D \
(7
gd
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12:99
Quad No:
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Sections) ry f ) A fD
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone] C ! lJ
WELL CONSTRUCTION RECORD
WELL CONTRACTOR- Dewey Wright Well Pump Co
WELL CONTRACTOR CERTIFICATION #- 2686
020865 STATE WELL CONSTRUCTION PERMIT#• Leclie Reece
Inc
1. WELL USE (Check Applicable Box): Residential
Recovery El Heat Pump Water Injection
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town' G, N{ERSVILLEE
Municipal 0 Industrial fl
Other If Other, List Use.
County.
MITC,IIELL
oavrvamearem,mndrs; cammu
3. OWNER LIZ A. M4HAFFEY
Address 391,c rAf, cee Cr oikec Noo. P
1 or note
city or roteet4ERSVII Lc
State
lion and Lot No.)
NV' 247pQ5de
4. DATE DRILLED 2,.i/20112
5. TOTAL DEPTH 505
6. CUTTINGS COLLECTED YES 0 NO
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO
8. STATIC WATER LEVEL Below Top of Casing: inn FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm)' 8 METHOD OF TEST Air
11. WATER ZONES (depth)•d nom SQ1-1A".7 d onm d57-45R
0 anm 0 nnm
12. CHLORINATION: Type HTH Amount 85
Agricultural El Monitoring 0
DRILLING LOG
From To
4 &1
DEPTH
Formation Description
MUD ("LAY
94 qg1 rRAmiTE
30I 'a DO
CUAPT7
ag2 457 GRAUTE
AR7 /`B nLIA17T7
458 505 GRANIITR
13. CASING:
x
If add
onal space is needed use back of form
Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To P7 Ft 8 1/4 1E9 r; ALi/ Roads, or other map reference points)
From To Ft .Ji%
From To Ft \C'e S
14. GROUT:
Depth Material Method
From 0 To 20_ Ft Cement Gravity. n)nw
From To Ft
15. SCREEN:
Depth
From To
From To
From To
Diameter Slot Size Material
Ft in in
Ft in in
Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To
From To
17. REMARKS:
I DO HEREBY CE
CONSTRUCTION S
Ft
Ft
1jftWELL.WAS C
ANDpROS, AND THAT A..CQ
FOR OFFICE USE ONLY
Quad No'
Serial No
2 SIG
Submit original tk
3
ck-
TED IN ACCORDANCE WITH 15A NCAC 2C, WELL
IS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
0
W
e 3-3-03
SON CONSTRUCTING THE WELL DATE
ater Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
4

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
030108
2r72312
WELL CONTRACTOR' Dewey Wright Well Pump
WELL CONTRACTOR CERTIFICATION #• 2681
STATE WELL CONSTRUCTION PERMIT#. Steve Petty
Co., Inc.
1. WELL USE (Check Applicable Box): Residential
Recovery Heat Pump Water Injection
I x4
Municipal I 1 Industrial I I Agricultural I I Monitoring
Other I I If Other, List Use*
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: -PRI ICF Pi N(F County M(TCL4J
.IC HNCON rFMFTFPY R I fFF TOP CANJG rn ncR HVV
(Road Name and Numbers. Community, or Subdivision and Lot No.)
3. OWNER . I404PS ` II pngTi iN
4.
5.
6.
7.
8.
Address 1AE?? H4YY 7?F R1clPTH
R.A4iFRSjso-ert�r ot�te o
City or Town State
DATE DRILLED S/213J711f=,
TOTAL DEPTH 4!l5;
CUTTINGS COLLECTED YES
NO
14
Zip Code
DOES WELL REPLACE EXISTING WELL? YES I I NO
STATIC WATER LEVEL Below Top of Casing: 100 FT
(Use "+" if Above Top of Casing)
DRILLING LOG
From
To
fl 1^
1115
1fl 1lt
DEPTH
Formation Description
cal pi'
GRAM -Dr
PHAI P
111t3 0;70 GRANITE
47i1 . HAI F (ll tART7
071 4ln iR.ANiTE
9. TOP OF CASING IS FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): _ 2 METHOD OF TEST Air
11. WATER ZONES (depthl• 1 qpm 105-106 1 qpm 370-371
0 qpm 0 qpm
12. CHLORINATION: Type HTH Amount 64
13. CASING:
If additional space is needed use back of form
Wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From ^ To 2n, Ft 61'R :5Q PVC t,�
- ry � Roads, or other map reference points)
From To Fte,
tr
Depth Material Method --..5
From 0 To 20 Ft Cement Gravity Fioirs
From To Ft
From To Ft
14. GROUT:
15. SCREEN
Depth Diameter Slot Size Material
From To Ft in in.
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth
From To
From -_ To
17. REMAR
IDOHE
CONSTF
Size
Material
Ft
Ft
£uii IFY IHAI IHIS WEL
ON STANDARDS, AND TE
FOR OFFI DE USE ONLY
Quad No:
ubmit o
uFFiCE
CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
:OPY OF THIS RECORD HAS BEEN PROVIDED TO THEE WELL OWNER.
°J
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
ginal to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No
ASP" '<IU_E F,

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
280267
WELL CONTRACTOR: Dewey Wright Well Pump Co. Inc.
WELL CONTRACTOR CERTIFICATION #• 2688
030339-1 STATE WELL CONSTRUCTION PERMITS Leslie Reece
1. WELL USE (Check Applicable Box): Residential
Recovery I I Heat Pump Water Injection
X
Municipal ❑ Industrial P Agricultural 0 Monitoring I I :-
Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: SPRI ICE PINP County: MITCHELL
DRILLING LOG DEPTH-;
3. OWNER BILI PRPMIDERGAST, JR.-L-MaRV PRCNDEP EAST From To Formation ¶rescription
Address Pn Pnaci 0 F5 DIRT
fit e r ' aou [
oaa amean um ers, ommunitv,orW 19 E
a No.)
reo
City or TowPRUn F PINE State
NC 2 7, Cdde
4. DATE DRILLED 9/8/20R3
5. TOTAL DEPTH 6115
6. CUTTINGS COLLECTED YES NO
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO Lx]
8. STATIC WATER LEVEL Below Top of Casing. FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 0 METHOD OF TEST Air
11. WATER ZONES (depth)• 0.00 cam DRY HOLE 0.00 gym
0.00 aom 0.00aom
S5 605 GRANITE - —
1
12. CHLORINATION: Type HTH Amount If additional space is needed use back of form
13. CASING: wall Thickness LOCATION SKETCH
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From f1 To RR Ft R 1/R R5(1 PVC Roads, or other map reference points)
From To Ft.
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft CEMENT GRAVITY FI OW
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in.
From To Ft in. in.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS•
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A^COOPPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
03
SI ATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit origins Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
FOR OFFICE USE ONLY
Quad No:
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
280287
WELL CONSTRUCTION RECORD
030440
WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #. 2686
STATE WELL CONSTRUCTION PERMIT#: Leslie Reece
1. WELL USE (Check Applicable Box): Residential ® Municipal 0 Industrial n Agricultural I I Monitoring El
Recovery 0 Heat Pump Water Injection n Other D If Other, List Use•
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: CPR( 1f E PINF County: MITCHEL(
1-111MpRAr'C MTN �n OFF HL,IMPBAr14 Po OFF ALT
1 oa• ame an Numbers, ommumty, or Subdivision and o o l
3. OWNER RCINNIP 1 FORBFS
Address 1R2 WAI IS,AcF AVF
tree or oute NoS
City or Town
State --- —Zip Code
4. DATE DRILLED Q/1/2f1f3
5. TOTAL DEPTH 125
6. CUTTINGS COLLECTED YES 0 NO H
7. DOES WELL REPLACE EXISTING WELL? YES I I NO
8. STATIC WATER LEVEL Below Top of Casing: 2n FT
(Use "+' if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm). 20 METHOD OF TEST Air
11. WATER ZONES (depth1i0.00 gpm 58-59 O.00gpm
0.00 gpm 0.O0gpm
I xl
DRILLING LOG
From To
DEPTH
Formation Description
0 20 DIRT
20 58 GRANITF
JAB 5B _C6WAI F
F9 125 GRANITE
12. CHLORINATION: Type HTF1 Amount 22
If additional space is needed use back of form
13. CASING: LOCATION SKETCH
Wall Thickness
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From fl To 21Ft R 1/8 Inn PVC Roads, or other map reference points)
From To Ft I / cb-/1NJ t,~e—
From To Ft -hS '
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement lravi Flan
From To Ft rFMFNT GRAVITY PI OW
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
WUrn ..ckmi-n. eci
G1<"-
A-I#&-ass Rd
21
8 30--4\
0
o 23 n
�'+ cn Ln
o<
F 's rn
:1=-0
3 rn
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
Ak-ecIb % -4 3
SIGNAT) OF PERSON CONSTRUCTING THE WELL DATE
Submit original to D ion of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
FOR OFFICE USE ONLY
Quad No:
—4
Serial No.

North Carolina - Department of Environment and Natural Resources -Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
280288
WELL CONTRACTOR- Dewey Wright Well Puma Co.. Inc.
WELL CONTRACTOR CERTIFICATION #- 2688
030441 STATE WELL CONSTRUCTION PERMIT#• Leslie Reece
1. WELL USE (Check Applicable Box): Residential ® Municipal
Recovery I I Heat Pump Water Injection n Other
Industrial D Agricultural D Monitoring P
If Other, List Use I
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: sPRLCcPinNE County: MITCHELL
OFF
oa a e n b rs, o o I o o.l
3. OWNER pUSSFLI S n1LLFR
Address POBOX&17 Por Route No.)
City or TBEAUFORT own State
SC 2KITS1817
4. DATE DRILLED Qn/7nn4
5. TOTAL DEPTH dn5
6. CUTTINGS COLLECTED YES 0 NO
7. DOES WELL REPLACE EXISTING WELL? YES El NO
8. STATIC WATER LEVEL Below Top of Casing: 1n FT
(Use'+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 0 75 METHOD OF TEST Air
11. WATER ZONES (depthl' n 75__rtnnali3-11:4 0 00aam
0 00 aom 0 00aom
12. CHLORINATION: Type HTH Amount 77
13. CASING:
x
Wall Thickness
Depth Diameter or Weight/Ft. Material
From D To 6‘Ft R 1/R 0,5n Pvc
From To Ft
From To Ft
14. GROUT:
From
From
Depth Material
0 To 20 Ft Cement
To Ft CEMENT
15. SCREEN:
DRILLING LOG
From To
DEPTH
Formation Description
0 60 MUn GRAVEI
60 1R3 GRANITE
1133 1R1 Q1-IA1 F
18d 405 fRANITF
If additional space is needed use back of form
Method
Gravity Flow
GRAVITY FI OW
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in.
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
LOCATION SKETCH
(Show direction and distance from at least two Stipcp JLQ
Roads, or other map reference points)A CD\ ptf
17. REMARKS•
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
SIGfIYATURE OFfERSON CONSTRUCTING THE WELL DATE
Submit origins o Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
-03
Serial No.

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
280293
WELL CONTRACTOR: Dewey Wright Well Pumo Co . Inc
WELL CONTRACTOR CERTIFICATION it: 2888
030339-3 STATE WELL CONSTRUCTION PERMIT#' I Pslie Reece
1. WELL USE (Check Applicable Box): Residential I gl
Recovery I I Heat Pump Water Injection I I
Municipal I I Industrial 0
Other 0 If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: SPPUCEPINE County: .sitx we L
(lFF RAPPIT Hf1P PD f1FF PFNI AND Prl r1FF 10C
j oaad Name and Numbers. l:ommumty, or ouodrvision and Loo rvu.i
3. OWNER BILI PRFNDERGAST JR, / MARK PRFNDPPGART
Address PO ROX gal
ttreet'or Route No.)
ty or Town----- — State
4. DATE DRILLED A/1n/2nf1R
5. TOTAL DEPTH 305
6. CUTTINGS COLLECTED YES n NO
7. DOES WELL REPLACE EXISTING WELL? YES I I NO I XI
8. STATIC WATER LEVEL Below Top of Casing: SO FT
(Use "+' if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm)' METHOD OF TEST Air
11. WATER ZONES (depth)' 4 00 wpm 189-164 n no ppm
fl nn aflm n nnnpm
12. CHLORINATION: Type I-ITH Amount 53
p Code
13. CASING:
From
From
From
Depth
0 To
To
To
14. GROUT:
From
From
Diameter
6R Ft 81/R
Ft
Ft
Wall Thickness
or Weight/Ft. Material
35n PVR
Depth Material
0 To 70 Ft Cement
To Ft. CFMFNT
15. SCREEN
DRILLING LOG
From To
0- 59
Agricultural Monitoring
483 16a
164 qO5_
Formation_Dpscription I `'
F9 463 GRANITE,,; __
SHALE
GRANITE
JIIRT
If additional space is needed use back of form
Method
Gravity Flow
GRAVITY FI OW
Depth Diameter Slot Size Material
From To Ft. in in
From To Ft in in.
From To Ft in in
16. SAND/GRAVEL PACK:
Depth
From To
From To
Ft
Ft
Size Material
17. REMARKS.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
RE F PERSON CONSTRUCTING THE WELL
LOCATION SKETCH
(Show direction and distance from at least two State
Roads, or other map reference points)
FOR OFFICE USE ONLY
SIGNATU
Submit original to Divis' of Water Quality, Groundwater Section within 30 days
DATE
Quad No:
Serial No.
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
280266
WELL CONSTRUCTION RECORD
0303313-2
WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #: 2686
STATE WELL CONSTRUCTION PERMIT#: Leslie Reece
A,
1. WELL USE (Check Applicable Box): Residential ® Municipal ❑ Industrial
Recovery 0 Heat Pump Water Injection E Other If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: SPRUCE PINE County: MITCHFII
OFF RARRIT HOP Rf1 OFF PFNI AN() Rfl OFF 1QP
(Road Name and Numbers, Communtty, or Subdivision and Lot No.)
3. OWNER RII I PRFNOFRGART, IR / MARK PRFNfFRGAST
Address PC) ROX fg1
SPRUCF leri r Route No.) NC 2R777
City or Town State ip Code
4. DATE DRILLED Win/2IVfl
5. TOTAL DEPTH 5EF
6. CUTTINGS COLLECTED YES NO
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO
8. STATIC WATER LEVEL Below Top of Casing: FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm) 0 METHOD OF TEST Air
11. WATER ZONES (depth): 0.00 ppm DRY HOLE 0.00ppm
I)4
0.00 ppm 0.00gpm
X
Agricultural E Monitoring
DRILLING LOG
From To
0 5
DEPTH
Formation Description
11RT
5 Ff15 GRANITF
n
12. CHLORINATION: Type HTH -. Amount If additional space is needed use back of form
13. CASING: LOCATION SKETCH
Wall Thickness
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least two State
From 0 To 71 Ft R 1141 1RR GAI V Roads, or other map reference points) �=
From To Ft (...., n pt(S
From To Ft Ca 0
—,I CT ;� 3
U t r
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft CEMENT GRAVITY FI OW
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in. in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
I
17. REMARKS'
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
lam% t /O -6 - 03
SI ATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit origin to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
FOR OFFICE USE ONLY
Quad No:
W
Serial No.

WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONSTRUCTION RECORD 27,g2 82
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR COMPANY NAME Tns
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ASSOCIATED WQ PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential all Municipal/p bl ❑Industrial
0
Agricultural 0
CERTIFICATION
PHONE # ( )
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATIO
Nearest Town:
County
-lYZigte2
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address R37 zhi n 7 t
(Street or Route No.)
/41-4 ,tc. C
City or Town State
( )-
_2.e777
Zip Code
Area code- Phone number
4. DATE DRILLED g•-/Z- o 5
5. TOTAL DEPTH: afros•
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO a/
7. STATIC WATER LEVEL Below Top of Casing: ,2 FT.
8. TOP OF CASING IS (Use "+" if Above Top of Casing)
FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118.
Depth
From To Ft
From 0 To L/? Ft
From n To_ e�' j Ft
13. GROUT: Depth
Method
From
To Ft.
From TO 70 Ft. LL,`/ /
14. SCREEN: Depth Diane r Slot Size
M erial
From
To PL in. in.
From To Ft. in.
15. SAND/GRAVEL PACK in.
Depth
From To
From To
9. YIELD (gpm): __ METHOD OF TEST A/tz
10. WATER ZONES (depth):
11. DISINFECTION: Type e trot free Amount -802
12. CASING: Wall Thic ness
Diameter or Weight/Ft. Material
16. REMARKS:
Material
Size
Ft.
Ft.
Material
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARD / D THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Topographic/Land setting
❑Ridge ❑Slope I4Iley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
Y� ,6s"
LOCATION O g
Show direction and distance in miles from at433st
two State Roads or County Roads. Include armload
numbers and common road names. -0 cry:
�1
3>c
azz?
.+re c
wyec
rat., t.lf o
h /
" oaf
IGNA
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. (919) 733-322I, within 30 days.
GW-I REV. 07/2001
OF PERSON CONSTRUCTING THE WELL

WELL CONSTRUCTION RECORD
7625--26
2792.73
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) (].r9"/211 (E CERTIFICATION # 2i5a�(
PHONE # f a y.463/ j{�
\CELL CONTRACTOR COMPANY NAME
TOSFicl Lott( 6r:1(:A,
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 82 Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: yy�
Nearest Town: ,. u,.c.¢1.l -.a- County 4),
50 kitt21,:j sttA4
(Street Naas, Numbers, Community, Subdivision, Lot Nt, Zip Code)
3. OWNECI) vt ci G A2Soti/
Address VCL2y4.44tt
(Street or Route No.)
S;HdnP.u, AlC
City or Town State
2R777
Zip Code
( v)- '76s--2 c.sz
Area code- Phone number
4. DATE DRILLED g-
/0-03
5. TOTAL DEPTH: 5-65`
6. DOES WELL REPLACE EXISTING WELL? YES c 10 ❑
7. STATIC WATER LEVEL Below Top of Casing: 66 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 9 METHOD OF TEST me
10. WATER ZONES (depth): (lgC>.e 4,7 4:05-
11. DISINFECTION: Type C',erYtt7v,
12. CASING:
Depth
From To Ft
From 0 To 77 F
From '7 7 To 79 Ft
13. GROUT: Depth
From To
From 0 To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
Amount ral07jj„
Wall Thickness
Diameter or Weight/Ft. Material
i
aterial ethod
Topogra /Land setting
❑Ridge ope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreespninutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
70 - rQC erin
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include -the r4il
numbers and common road names. r� 0
Ft.
Ft. .9 711(4.,41
Diameter Slot Size Material .
Ft. in. in. j
Ft, in. in.
Size
Ft.
7 Material
Ft.
I DO HEREBY CERTIFY THAT THIS WELL
CONSTRUCTION STANDARDS, AND THA"
SIGNATUR
g-F
y . a
rn 9
9 cc)
�D 0<
�rn
0
�1� Qwm
MCfl z
.tom --I
Gf1
ir-Vil
' vl10
jt AS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
COPY OF THIS RECOR HAS BEEN PROVIDED TO THE WELL OWNER
OF PER ONSTRUCTING THE WELL
DATE
0
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC- L___
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/:001

WELL CONSTRUCTION RECORD 27949'a
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM (print � / 4 , lea eTn� ,� ,e Q CERTIFICATION #n2 D %%
Lf leG/ RLtLGL7 ZL' PHONE p
.AtSOC1ATED WQP aERAIIT#
(if applicable)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT/
(if applicable)
1. WELL USE (Check Applicable Box): Residential W. MunicipallPublic ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATIO, Nearest Town: Cotmty /%F [ c(//
577 - -%' of 9S277
(Street Name, Numbers, Community, SS�uubd��ivisioo, Lot No., Zip Code)
3. OWNERS i/c/.,kkd .CL4
Address �' 77 iflelisrruoS44h •
» 7 Wei
^ (street AtR No.)
r.
City or r State zip code
(rif)- 7/�-6— —,O */...5-4
Area code- Phone comber
4. DATE DRILLED f///�/) 3 -
5. TOTAL DEPTH: :3 PS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 2
7. STATIC WATER LEVEL Below Top of Casing: SY'S FT.
(Use ^r" if Above Top of Casing)
8. TOP OF CASING IS I .S FT. Above Land Surface*
'Top of casing terminated at/or below land surface require ■
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): f THOD OF TESTti..r
10. WATER ZONES depth): /D — 3120
11. DISINFECTION: Type 2/ �. Amount la-'f 7
12. CASING: V Wall Thickness
Depth Diameter or Weight/Ft Mpunal
From To Depth,
Ft. 9 / f/✓('
Fromm_ To Ft.
From To Ft
13. GROUT: Depth From 0 To ,,% p Ft f eMantureriaelij
From To Ft
14. SCREEN: Depth Diameter
From To Ft. in.
FroTo Ft. in.
15. SAND RAVEL PACK:
Depth Size
From To Ft.
From `To Ft.
16. REMARKS:
Material
Topographic/Land setting
❑Ridge I&Slope ❑Valley 0Flat
(check appropriate box)
Latitude/longitude of well location
TO
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topo$rph _map ---_-
(checkbox)
DEPTH DRILLING LOG 7:: J
From To Formation Descnption
0
r
rA
LOCATION SKETCH ry
Show direction and distance in miles froni$1eas c
two State Roads or County Roads. Include -die ro221--
numbers and common road names. _ ^ o
cooz
(V n�
CO z
z
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
6ai, 4/n /0 3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD 279192
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION #nl D 77
HONE (1
OCIATED WQ PERMIT./ /V n
(if applicable)
WELL CONTRACTOR (INDIVIDUAL) NAM
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
(print
6i19-oVBa
I. WELL USE (Check Applicable Box): Residential CV Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATIC :
Nearest Town: County 11 E 7 7
(Street Nuns umber, Community. Suiditom, Lot No., Tip Code)
3. OWNER: r(Yaa-e:0" -¢tc-
Address -47; g ge&iev4i in°irr (ea
(Street or Rowe N4City or State
9
Zip
(Ann- s3 d-:.of, a2tiZ— Code
Arms code- Phooe number
4. DATE DRILLED Q/ ?/ D 3
5. TOTAL DEPTH: 7 0 s
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Iill.
7. STATIC WATER LEVEL Below Top of Casing: /S FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 1SA NCAC 2C .0118. -
9. YIELD (gpm): 3 0 METHOD OF TEST -re-no
10. WATER ZONES (depth): 9D ' / %4 t
11. DISINFECTION: Type ./lers�w Amotmt e � at
12. CASING: !/ Wall Thickness
Depth Diameter or Weight/Ft Material
Front i2__ To . tS Ft to r/ 4.1. / Pile -
From To Ft.
From To Ft
13. GROUT: Depth Material
From 0 Toalfi_ Ft raila•4
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in.
From To Ft in.
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:. 5 f( v4 4
in.
in.
Topographic/Land setting
❑Ridge ❑Slope EJVailey ❑Flat'
(check appropriate boo)
Latitude/longitude of well location
(degrees/mimtses/seeoods) �
Latitude/longitude source:❑GPS❑Topugraphic map 's 1�I
(check) E�. _ _J
DEPTH P
RILL G
From To Formation
c
0
c>>
1 : � • N. �. —0 C"
Show direction and distance in miles frotsat Ieag
two State Roads or County Roads. Includkiine r
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
adie V?Io,3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DA
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]r+
WELL CONSTRUCTION RECORD WELL CONTRACTOR. Dewey Wright Well Pump Co., Inc.t)
WELL CONTRACTOR CERTIFICATION #: 2 .
030478 STATE WELL CONSTRUCTION PERMIT'S. Stesi Ke*c /Qy F
111 ),
1. WELL USE (Check Applicable Box): Residential I vI Municipal Industrial fl Agriculture
Recovery Heat Pump Water Injection Other If Other, List Use.
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: PAKERSVII 1 F County M!TCHP! I
OFF HWY 261 OFF HWY 7?8 OFF HWY 1AF
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER WANDA J CRISP
Address 6387 HWY 261
Isheet Route "a)EIAKERSvILL NC 287Qc5 e 35 9!0 SHAI F GRANITE
Zip od__ _.
SHALE
City or Town State
DRILLING LOG DEPTH
From To Formation Description
0 35 DIRT
4. DATE DRILLED 9/30/2003 94 300 GRANITE
5. TOTAL DEPTH 300
6. CUTTINGS COLLECTED YES I I NO
I :d
7. DOES WELL REPLACE EXISTING WELL? YES NO
I xi
8. STATIC WATER LEVEL Below Top of Casing 10 FT.
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 10 METHOD OF TEST Air
11. WATER ZONES (depth)jO-00 ppm 90-94 0.00ppm
0.00 ppm 0.00gprn
12. CHLORINATION: Type HTH Amount 59
0
0 0 _'
N
J
If additional space is needed use backp.fornT.;
13. CASING: LOCATION SKETCH
Wall Thickness CJ --1
Depth Diameter or Weight/Ft. Material (Show direction and distance from at least -two Ste
From 0 To 42 Ft 6 1/4 .18A GALV Roads, or other map reference points) 1
From To Ft 111
From To Ft. pY'
14. GROUT:
Depth Material
From 0 To 20 Ft Cement
From To Ft CEMENT
15. SCREEN:
cc,_ r,1:.r1
a3-4.0 --=r
Method
Gravity Flow
GRAVITY FLOW
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft. in. in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
17. REMARKS: A�'�'ILhEOOiV'AL OFFICE
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2 Z
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD '413S BEEN PROVIDED TO THE WELL OWNER.
Rprok• y
FOR OFFICE USE ONLY
Quad No•
Ir'TER SECTION
-v
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99
Serial No

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
WELL CONSTRUCTION RECORD
030514
282010
WELL CONTRACTOR: Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION SP 2687
STATE WELL CONSTRUCTION PERMIT# Steve Reece
1. WELL USE (Check Applicable Box): Residential Municipal 0 Industrial n
Recovery I I Heat Pump Water Injection I I Other I I If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: GAKER'SVILLF County MITCHFIL
3. OWNER
Address
DALLAS YOUNG RD. OFF GREEN YOUNG CEMETERY R
(Road Name and Numbers, Community. or Subdivision and Lot No.)
LARRY J. GANTZ
5405 POLK CITY P.D. ,
City or Town State
4. DATE DRILLED 10/1/2003
5. TOTAL DEPTH 420
6. CUTTINGS COLLECTED YES I I NO
7. DOES WELL REPLACE EXISTING WELL? YES I I NO
8. STATIC WATER LEVEL Below Top of Casing: 70 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm) 2.5 METHOD OF TEST AIR
11. WATER ZONES (depth): 1.50 qpm 80-90 1.00ppm 380-385
0.00 qpm 0.00opm
From
0
DRILLING LO pc__; DEPTH
To Formation Desc
80 DIRT
ption
HAINES {.� 16&Tr "teNo.) FL 33844
T Zip Code
12. CHLORINATION: Type HTH Amount 71
13. CASING:
1 XI
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 85Ft B 1/4 .168 G,ALV
From To Ft
From To Ft
14. GROUT:
Depth Material Method
From 0 To 20 Ft Cement Gravity Flow
From To Ft
15. SCREEN:
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
bD 90 GRANITE
90 93 SHALE
93 210 GRANITE
210 212 QUARTZ
212 380 GRANITE
380 385 SHALE
385 420 GRANITE
C_
n
Ctt
If additional space is needed use back of forra
CAD
LOCATION SKETCH
(Show direction and distance from at least two Stata
JLC�r Roads, or other map reference points4(S)
as
0
job" et
4-1 UP
Grieriar Ed,
L7
17. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A PY OF THIS RECORD S BEEN PROVIDED TO THE WELL OWNER.
/9-00o3
FOR OFFICE USE ONLY
Quad No:
Serial No.
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit original to Division of Water Quality, Groundwater Section within 30 days
GW-1 REV. 12/99

North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1636 Mail Service Center - Raleigh, N.C. 27699-1636 - Phone [phone]
292366
WELL CONSTRUCTION RECORD
WELL CONTRACTOR- Dewey Wright Well Pump Co., Inc.
WELL CONTRACTOR CERTIFICATION #• 2686
030604 STATE WELL CONSTRUCTION PERMIT#- Leslie Reece
1. WELL USE (Check Applicable Box): Residential Xd Municipal n Industrial 0
Recovery 0 Heat Pump Water Injection 1 Other n If Other, List Use:
2. WELL LOCATION: (Show sketch of the location below)
Nearest Town: BURNSVII LE County: MITE HFLI
POP AR RD/HWY 197 a OFF RFLFIT RF) TIFF TOF RIVE
(Road Name and Numbers, Community, or Subdivision and Lot No.)
3. OWNER ELLIS BENNFTT
Address P 0 BOX252
ERWIN (veetorRoute No.) 37650
City or Town State Zip Code
DRILLING LOG
From
0
To
63 MUD
63 80 GRANITE
RO
4. DATE DRILLED 11/26/2003 81
5. TOTAL DEPTH 125 194
6. CUTTINGS COLLECTED YES ❑ NO 105
7. DOES WELL REPLACE EXISTING WELL? YES 0 NO 15
8. STATIC WATER LEVEL Below Top of Casing: 20 FT
(Use "+" if Above Top of Casing)
9. TOP OF CASING IS 1 FT Above Land Surface*
*Top of casing terminated at/or below land surface requires a variance in accor-
dance with 15A NCAC 2C.0118
10. YIELD (gpm): 10 METHOD OF TEST Air
11. WATER ZONES (depth): 6.00 ppm 80-81 4.00ppm 104-105
0.00 ppm 0.00ppm
12. CHLORINATION: Type HTH Amount 22
81 SHALE
104 GRANITE
105 SHALE
175 GRANITE
II
AgrictilktI I Monitoring Li
_1 JUN 2 5 2004
GROUNDWATER SECTION
ASNf`.ILL olif;flifih'9L OFFICE
Formation Description
c
13. CASING:
IA
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To _ell Ft 6 1/4 188 GALV
From To Ft
From To Ft
14. GROUT:
From
0 To 20 Ft Cement
From To Ft
15. SCREEN:
Depth Material Method
Gravity Flow
Depth Diameter Slot Size Material
From To Ft in in
From To Ft in in
From To Ft in in
16. SAND/GRAVEL PACK:
Depth Size Material
From To Ft
From To Ft
tV
lD Ern
If additional space is needed use bacWaf forre45
W
W —
0 o
LOCATION SKETCH
(Show direction and distance from at least two State/
\\t/ Roads, or other map reference points) yP
ICY
17. REMARKS: C
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
FOR OFFICE USE ONLY
Quad No:
SIG? TURE OF PERSON CONSTRUCTING THE WELL
Submit original to Division of Water Quality, Groundwater Section within 30 days
a
iteAL
1-a2-o y
DATE
GW-1 REV. 12/99
//
11
Serial No.

298632
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and (INDIVIDUAL)Natuurk Natural Resources - Division of Water Quality - Groundwater Section /
WELL CONTRACTOR (INDIVIDUAL) NAME (print) / flat y/%LN CERTIFICATION #3-21�
WELL CONTRACTOR COMPANY NAME `-4 4 SC:t LL-44/ —pram,5 en. PHONE ffj(v Ls?? J'Q
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: 3rtkc,
39}f24 Bt<,nr.h
County in, kh, //
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3.OWNER: 3:/I �cl�itx
Address B V out rr v 'Pn; n4
(Street or Route No.)
DkAfre
Ciry or Town State
1KIf3 )- 379 - 017'7
Zip Code
Area code- Phone number
4. DATE DRILLED 1-3Q -
5. TOTAL DEPTH: 325
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ISY
7. STATIC WATER LEVEL Below Toppf Casing: C 5— FT.
(Use "+" if Above Top of Casing)
3. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD(gpm)• S METHOD OF TEST
10. WATER ZONES (depth): c-200'
11 DISINFECTION: Type 11D H
12. CASING:
Depth Diameter
FromO To 5-3 Ft. 1,1'
From 5 Y To 5 Y Ft. (> %f
From To Ft.
13. GROUT: Depth
From 0 To an Ft.
From To Ft.
Amount 3e,z
Wall Thickness
or Weight/Ft. Material
SidRI
N3 51-e
Material
t.'ne re fe
Method
pbr
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
❑Ridge IQS%pe ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
Vain Dy./1040W
(degreesrminutesiseconds)
Latitude/longitude source:45PCrPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
66 f/�� lock
v
LOCATION SKETCH
0
—O rsG
Show direction and distance in miles from at least S rca
two State Roads or County Roads. Include the road n,
numbers and common road names. CJI GP Z
of/ir 0/4rLr_
IDuK`e rS✓.'/t'c
11 C.
16. REMARKS:
[ DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN !ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS,ND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1-03
DATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

Zip Code
Depth Diameter
From ® To y© Ft
From Lie. To �� Ft
From To
13. GROUT: Depth
From To � Ft
From To
14. SCREEN: Depth
From To
Ft.
Diameter
Ft. in.
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and N
tural Resources - Division of Water Quality - Groundwater Sectionio[�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 1l t C-Re /( CERTIFICATION#n(5l� eV}, `ca(l
WELL CONTRACTOR C011PA N9' NAME Y�ir%. .t-�K..PI l/ I ( PHONE # o QQ.
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ P IIT#
(if applicable) (if applicable)
303041
I. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCA II
Nearest Town:
CoS-\
(Street
ame, umbers, C
ty
ision, Lot No., Zip Code)
3. OWNER: m. 1 I Pi+-\-mi' t _
Address
, L¢sA�t�r0r 0a► _ e
air705
City or Town State
lift)- Gis%
Area code- Phone number
4. DATE DRILLED ii
5. TOTAL DEPTH:
6. DOES WELL REPLACE EX TING WELL? YES ❑ NO P]
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S i FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 7.,!? METHOD,QF TEST 64
Lfz-
O. WATER ZONES (depth): 9b- Igo 11. DISINFECTION: Type C\tOg-2pAmount l0 eC-
12. CASING: Wall Thickness
or Weieht/Ft. Material
t
Material Method
ca.a
Slot Size Material
in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
�7ropographic/Land setting
idge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To orm.tion Description
A ` 90
4-749— 5b
Scg
95-
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the®ad •,
numbers and common road names. re%
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION ST - NDARDS. AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/l. `-°3
SIGNATY,RE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV--.,07/20Q1

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAM.^EE (print) ieVj,�1 �tpezetJ CERTIFICATION+�Sq�
#
%A'ELI. CONTRACTOR COMPANY NAME -LI S oe I, L*.k,i r3lt ( II PHONE #
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION: ty Nearest Town.i, CouqtVeL. .�_ ��_�
TY l� k1w �c,t /Y `S
(Street Name, Numbers, Community, Subdivision, Lot No..,, Zip Code)
3. OWNER: / Df Gk- a &cid, 2v//ez
Address /20 %lASSf7tII Lr
I (Street orr Route No.)
nr.n Sur, l
iN 37100V
City or Town Statd Zip Code
( )-
Area code- Phone number
4. DATE DRILLED JL7"6o-b-3
5. TOTAL DEPTH: Imo
6, DOES WELL REPLACE EX TING WELL? YES ❑ NO 0
7, STATIC WATER LEVEL Below Top of Casing: FT.
(Use "4" if Above Top of Casing)
8, TOP OF CASING IS t FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C.0118.
9. YIELD (pm): 2'< METHOD OF TEST i4ift
10. WATER ZONES (depth): 4p01'10
11. DISINFECTION: Type
12. CASING:
From
From
From
ameter
Ft. 154Y
Ft.
Ft.
Amount ("oZr
Wall Thickness
or Weieht/Ft. Mate ial
13, GROUT: Material
From_ (t Ft. c e
From Ft.
14. SCREEN: Diameter
From Ft. in,
From Ft. in.
15.
Depth Q
To 51
To
To
Depth
To
To
Depth
To
To
Method
Slot Size Material
in.
in.
SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16.REMARKS:
Topographic/Land setting
L]&(ge OSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
DEPTH
From To
Ci — iZ
Sia BR,
re, /co
LOCATION SKETCH
Show direction and distance in miles from affiast
two State Roads or County Roads. Include the0oad
numbers and common road names.co
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION S"f/ANDARDS,H/pT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
�-- 1OL‘, 03
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
c2
ci

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 4O./
WELL CONTRACTOR COMPANY NAME y`e_1I , L
ek
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential, Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: 'Vti ,�1 —
Nearest Town: g tC
County t1iCiC
(Street Name. Numbers, Community. Subdivision, Lot No.. Zip Code)
3. OWNER: At SA alv
Address 2-13G ti`2d
(Street or Route No.)
cif)a ilrrtg., le Yam, a4 IOC
City or Town State Zip Code `�)-"C; 7c�-.et7
Area code- Phone numbe
4. DATE DRILLED �—t' t ''O %
5. TOTAL DEPTH:
6. DOES WELL REPLACE EX TING WELL? YES 0 NO CJ
7. STATIC WATER LEVEL Below Top of Casing: C-0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS i FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance wi I5A NCAC 2C .0118.
9. YIELD (gpm): _ METHOD OF TEST . "R.
10. WATER ZONES (depth): CcC1 ar'lO
11. DISINFECTION: Type rk\ Ito k.--Amount C ac ,
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To ( Ft. 6 '1-1 :NOR-2 k `PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From ("� To '.2 'S Ft. Ceo
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
303049
CERTIFICATION in S ei
PHONE # 13.2i) 3D2
Topographic/Land setting
f2lidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
For ation Description
DEPTH
From To
as r3'(O
J
O".
t t
LOCATION SKETCH -rt
O r^'=
Show direction and distance in miles from at ejct mil,
two State Roads or County Roads. Include the koad -8
numbers and common road names. c0
O
O op
WC)
N to
tT c:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C. WELL
CONSTRUCTIOIy.STAND $DS.NR THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
(g ©;3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Reso s—DDivision of Water Quality - Groundwater Section
`q�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ‘,MC) '•�1"'r..WeSea CERTIFICATION#257�/^�
WELL CONTRACTOR COMPANY NAME F\ t l' CAM 1 c!rl_Yl --_ PHONE # &t%3 —o/, R
SLATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ�PER:MIT#
(if applicable) (if applicable)
303102
I. WELL USE (Check Applicable Box): Residential er Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ if Other, List Use
2. WELL LOCATION:
Nearest Town AA-5 CountyLA
(Street Name. Numbers, Community. Subdivision, Lot No., Zip Code)
3.OWNER: 'I (fl '.-
Address AR 1 [Bins CRf '\&
I Str t r Raule No
%rtgY C. t
City or Town State Zip Code
( Area code- Phone number
4. DATE DRILLED JD- 17 -1::53
5. TOTAL DEPTH: 3613
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: jO FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance wit 15A NCAC 2C .0118.
9. YIELD (gpm): k 2---METHOD OF TEST-Attec,
10. WATER ZONES (depth): i_Cra -ram
Type rAM —t Amount
II. DISINFECTION
12. CASING:
Depth
From to To it,
From Id To 30
From To
13. GROUT De
From To
From To
14. SCREEN: Depth
From To Ft.
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size
From To
From To
Ft
Ft
Ft
Diameter
T,el5 graphic/Land setting
tdge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description N
/. - Z ri
Csf—
Wall Thickness
or Weight/Ft. Material
a It ?�G
Depth Material Method
P Ft. !•vs-�` r_A
Ft.
Diameter Slot Size Material
in. in.
in. in.
Ft.
Material
Ft.
LOCATION SKETCH
CD
Enrn
Show direction and distance in miles from aERast C
g two State Roads or County Roads. Include throad yo
numbers and common r ad names. CO �>
is l rein
Vo a�
o �v
c,..) mp
Ca
-1 2�
VW")
fir- OOP
Bv'" _ fri
16. REMARKS:
I DO HEREBCERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUQ'fION STAND S. AN "�if1AT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
a it - /3_03
SI'Z,NATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001